Description:

AMC-046 Adverse Events Form (ADV) Cidofovir in Treating HIV-Infected Patients With High-Grade Squamous Intraepithelial Lesions of the Skin Near the Anus Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=7D8985E5-2E37-08A5-E040-BB89AD434A3B

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=7D8985E5-2E37-08A5-E040-BB89AD434A3B

Keywords:
Versions (4) ▾
  1. 8/26/12
  2. 1/9/15
  3. 1/9/15
  4. 1/9/15
Uploaded on:

January 9, 2015

DOI:
No DOI assigned. To request one please log in.
License:
Creative Commons BY-NC 3.0 Legacy
Model comments:

You can comment on the data model here. Via the speech bubbles at the itemgroups and items you can add comments to those specificially.

Back to model comments
Itemgroup comments for:

Item comments for:

In order to download data models you must be logged in. Please log in or register for free.

Anal Cancer NCT00550589 Toxicity - AMC-046 Adverse Events Form (ADV) - 2989394v1.0

Details

Based on information entered, an AdEERS Report must be submitted. Please go to the CTEP website and access the AdEERS system

Header
Unnamed2
Was this event expected or anticipated
CTC Adverse Event Attribution Code
Alternative etiology
Action Taken at Time of Adverse Event
3 more items in the detailed view.
If modification was made to study therapy, who initiated modification
Unnamed3
Outcome of Adverse Event
Was this considered a Serious Adverse Event
Seriousness Attributed to Adverse Event (If "Yes" check "Yes" for all that apply Please note that checking "Yes" to any of the events below will require SAE notification according to protocol requirements.)
3 more items in the detailed view.
Comments
Back to the top of the page